Individual provider Active NPI

Nicholas Jerome Kitowski, M.D.

  • Surgery Physician
  • Black River Falls, WI
National Provider Identifier
1720245103
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
50966-020 Issued in WI
Practice address
610 W Adams St
Black River Falls, WI 54615-9010
Phone
(715) 284-4311
Fax
(715) 284-0475
NPI assigned
May 22, 2008
Last updated
Jun 30, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 50966-020 WI Primary

Addresses

Primary practice location

610 W Adams St
Black River Falls, WI 54615-9010

Mailing address

610 W Adams St
Black River Falls, WI 54615-9010
Phone (715) 284-4311

Other practice location 1

711 W Adams St
Black River Falls, WI 54615-5052
Phone (715) 284-5361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110803000759 WI Practitioner - General SurgeryPractitioner - Hospice/Palliative Care 4789853953 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Hospice/Palliative Care
Education
Medical College of Wisconsin, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Black River Health IncGroup PAC ID 3173431178, 62 clinicians

Practice addresses (Care Compare)

711 W Adams St
Black River Falls, WI 54615-5052
Phone (715) 284-5361

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
50966-020WIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Black River Health Inc CurrentSince Dec 30, 2024 Accepting new patients
Black River Health Inc CurrentSince Dec 30, 2024 Accepting new patients
Krohn Clinic LTD. CurrentSince Aug 15, 2011 Accepting new patients
Black River Health Inc CurrentSince Jan 18, 2026 Accepting new patients

Locations

610 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-4311

711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-1302

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BHJBDA
  • Direct secure messaging: nicholas.kitowski@kcld.eclinicaldirectplus.com
  • Direct secure messaging: nkitowski55102@direct.emplifyhealth.org

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Black River Health IncBlack River Falls, WI, CCN 521333 Hospital Corporate Director Dec 30, 2024
Black River Health IncBlack River Falls, WI, CCN 52Z333 Hospital Corporate Director Dec 30, 2024
Krohn ClinicBlack River Falls, WI, CCN 528643 Rural health clinic Corporate Director Dec 30, 2024
Black River Healthcare ClinicBlack River Falls, WI, CCN 528658 Rural health clinic Corporate Director Dec 30, 2024

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1720245103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159010",
            "telephone_number": "715-284-4311",
            "fax_number": "715-284-0475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159010",
            "telephone_number": "715-284-4311",
            "fax_number": "715-284-0475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 W Adams St",
            "address_purpose": "LOCATION",
            "city": "Black River Falls",
            "state": "WI",
            "postal_code": "546155052",
            "country_code": "US",
            "telephone_number": "715-284-5361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KITOWSKI",
        "first_name": "NICHOLAS",
        "middle_name": "JEROME",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-22",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "50966-020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Black River Falls, WI

Sources for this page

Verify at the official NPI Registry.